Spinal Cord Sarcoidosis Accompanied with Compressive Cervical Myelopathy

Abstract

Spinal cord Sarcoidosis was first described by Longcope in 1941 (Longcope, 1941), and since then, spinal cord involvement has been reported in less than 10% of patients with neurosarcoidosis (Bogousslavsky et al., 1982, Fried et al., 1993) Spinal cord sarcoidosis is a chronic, granulomatous, systemic inflammatory disease, although precise understanding of the pathogenesis remains unclear, and most commonly occurs at the cervical level, presenting with subacute or chronic myelopathy frequently progressing to paraplegia (Sauter et al., 1991, Morita et al., 1992). The mainstay of treatment of spinal cord sarcoidosis is high-dose corticosteroid therapy, and surgery is undertaken when suggested by biopsy results and histopathological diagnosis (Jallo et al., 1997). However, since the lower middle cervical segments are more frequently affected (Nagai et al., 1985), it is difficult to differentiate cervical spinal cord sarcoidosis from cervical spondylotic myelopathy when gradually occurring in elderly patients. Magnetic resonance imaging (MRI) findings with high signal intensity on T2 weighted images and vagueness of diffuse enlargement of the spinal cord due to spinal canal stenosis often leads to the surgeons to diagnose spinal cord sarcoidosis only after decompressive surgery has been performed for compressive cervical myelopathy. More than 80 cases of spinal cord sarcoidosis have been reported, most of which were studied using MRI (Kanzaki et al., 2004). There are no papers on the coexistence of compressive cervical myelopathy and cervical spinal cord sarcoidosis, and it is uncertain not only whether compressive cervical myelopathy triggers the development of inflammatory granuloma in spinal cord sarcoidosis but also the effect of decompressive surgery. In this chapter, the outcome of decompressive surgery performed for cervical spinal cord sarcoidosis accompanied with compressive cervical myelopathy and the effect of steroid therapy provided after decompressive surgery is expressed, comparing the outcome of the treatment of spinal cord sarcoidosis with no compressive cervical myelopathy shown by MRI.